A randomised clinical trial to study postoperative abdominal and shoulder tip pain following low and standard pressure laparoscopic cholecystectomy

Rahul Sandhu; Dronacharya Routh; Pankaj P Rao; K K Arunjeet

doi:10.1016/j.mjafi.2022.10.001

A randomised clinical trial to study postoperative abdominal and shoulder tip pain following low and standard pressure laparoscopic cholecystectomy

Med J Armed Forces India. 2023 Dec;79(Suppl 1):S230-S236. doi: 10.1016/j.mjafi.2022.10.001. Epub 2022 Dec 5.

Authors

Rahul Sandhu¹, Dronacharya Routh², Pankaj P Rao³, K K Arunjeet⁴

Affiliations

¹ Graded Specialist (Surgery), Military Hospital Panagarh, C/o 99 APO, India.
² Professor (Surgery), Base Hospital, Srinagar, C/o 56 APO, India.
³ Professor (Surgery), Command Hospital Lucknow, India.
⁴ Assistant Professor (Surgery), Military Hospital Pathankot, India.

PMID: 38144636
PMCID: PMC10746830 (available on 2024-12-01)
DOI: 10.1016/j.mjafi.2022.10.001

Abstract

Background: Laparoscopic cholecystectomy (LC) has become the gold standard for the management of symptomatic gallstone disease. The complications related to different pressure ranges of pneumoperitoneum have been studied widely with no definite conclusion till date. The current study was planned to determine the effect of standard versus low pressure laparoscopic cholecystectomy (LPLC) on postoperative abdominal and shoulder tip pain (STP).

Methods: The present randomised clinical trial included 84 patients divided into two groups: standard pressure laparoscopic cholecystectomy (SPLC) (13 mmHg) and LPLC (9 mmHg). The variables tested were abdominal pain at 3, 6, 12 and 24 h (by verbal rating scale), the incidence and intensity of STP, post-operative nausea and vomiting (PONV) and surgeon's comfort for the two techniques.

Results: The demographic characteristics of patients were similar in both groups. In LPP group, the postoperative abdominal pain at 6, 12 and 24 h was significantly less than SPLC; p = 0.02. Incidence of shoulder pain was significantly less in low pressure group (7.14%) compared with standard pressure (28.57%).

Conclusions: Low-pressure pneumoperitoneum (LPP) is safe and feasible surgery with reduced abdominal and STP.

Keywords: Laparoscopic cholecystectomy; Pneumoperitoneum; Post-operative nausea and vomiting; Postoperative pain; Shoulder tip pain.